Minimally invasive video-assisted epicardial beating heart ablation for lone atrial
fibrillation claims to be safe and effective. We, however, report on three patients
with an atrioesophageal fistula after this procedure. The exact pathogenesis of this
complication is unknown. All patients presented around 6 weeks after surgery with
either fever or neurological deficits. Diagnosis can be made by computed tomography
scan. We advocate an aggressive surgical approach with closure of the atrial defect
on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal
muscle flap in a single-stage surgery. Some caution as to the low-risk character of
this procedure seems to be realistic.
Keywords
thoracoscopic ablation - atrioesophageal fistula - complication
